For kids, retail medical clinics not best choice: pediatricians

NEW YORK (Reuters Health) - In an updated policy statement,
the American Academy of Pediatrics (AAP) still says kids
shouldn't get their primary care from clinics at retail outlets.
But it acknowledges that the clinics have become more popular
and many people choose them anyway.

Retail medical clinics, first opened in the U.S. in 2000,
have popped up in grocery stores, drug store chains and "big
box" stores. There were more than 6,000 such locations in the
country as of 2012, according to the policy update published in
the journal Pediatrics.

Representatives from Walgreens and CVS, both national
drugstore chains with associated medical clinics at some
locations, largely agree with the AAP guidelines and do not
encourage people to use their services as primary care.

"We strongly encourage all patients to have a relationship
with a primary care physician and medical home for ongoing
medical needs and routine exams," Walgreens spokesman Jim Cohn
told Reuters Health.

The statement only refers to the types of clinics that are
built into other businesses, not freestanding "urgent care"
clinics, which have also grown in popularity and have some of
the same drawbacks.

According to the authors of the statement, taking kids to
retail clinics instead of primary care pediatricians fragments
care, since the kids don't always see the same medical provider.
A child could have chronic ear infections or other long-term
medical problems that seem to the providers at various retail
clinics like unrelated single events.

Pediatricians in "pediatric medical homes," Dr. James J.
Laughlin and his colleagues write, are more likely to notice
patterns in the child's health over regular visits. Laughlin is
a pediatrician based in Bloomington, Indiana.

Medical homes follow the traditional model of pediatric
care, first outlined in 1967, in which the family and primary
care provider work in collaboration for the child's medical and
non-medical care, holding all of the child's medical records in
one central location.

In its statement, the AAP Committee on Practice and
Ambulatory Medicine also expressed concern that retail clinics
may order tests and fail to follow up. Or they may have
cleanliness or public health issues, given that ill people are
congregating in a retail environment not subject to the same
sanitation standards as a doctor's office.

The authors note that pediatric primary care doctors use
visits for minor ailments as an opportunity to explore more
long-term subjects, like diet and exercise, which probably do
not come up at a retail clinic.

The statement largely reaffirms the AAP's position from a
similar statement in 2006, which would otherwise have expired.

In the update, the committee says it still supports medical
homes and opposes using retail clinics as a source of primary
care for children. If communities need to use the clinics as a
source of acute care when their regular pediatricians are not
available, there should be a formal set of rules for a
collaborative relationship.

The clinics should adhere to all standards for pediatric
care and be subject to review by pediatricians, the update
states. Also, all information relevant to the clinic visit
should be relayed back to the pediatric medical home as soon as
possible; if patients do not have a regular pediatrician, the
clinic should make arrangements to establish one.